Affordable Care Act (ACA)

HEALTH REFORM, CANCER AND YOU

The Patient Protection and Affordable Care Act (ACA) is the most significant health law to impact cancer care in decades. Unfortunately, the majority of Americans are still confused about the law and don't understand how it will affect them personally.[1] This site is intended to help those affected by cancer understand how the law might impact them. For some, health reform will have no noticeable effects. For others, it will mean the difference between access to lifesaving cancer treatments or foregoing care. The difference will largely depend on one's insurance status before reform.

For each major insurance category, we have included brief summaries of the most significant changes as a result of health reform. Also, to help illustrate how one's experience with cancer care could vary as a result of health reform, we have included examples of three individuals affected by cancer, and how they fare both before and after health reform. In each case, a scenario under the current system will be described, followed by a portrayal of likely changes after implementation. While these stories are fictional, whenever possible, they have been informed by the experiences of actual cancer patients.[2]

A few of the most meaningful highlights of the ACA include:

Insurance plans cannot deny coverage because of a pre-existing condition. For cancer patients this is a very important win. No longer can someone be denied insurance based on a previous diagnosis of cancer.

Insurance plans cannot charge higher premiums for those with health conditions, such as cancer. Currently, people with chronic illnesses or diseases may face higher premiums because of their illness. This added cost can sometimes mean the difference between an affordable policy and one that is just too expensive.

Insurance plans cannot drop someone's coverage just because they are diagnosed with cancer.

More insurance options for those with low to moderate income. Low-income cancer patients are often the most vulnerable. By expanding Medicaid and providing tax credits to help purchase insurance, more needy cancer patients will have access to insurance coverage.

No more lifetime limits on benefits. Annual limits on benefits will end in 2014.

Placing limits on out-of-pocket costs for care. Even those with insurance often have a hard time paying for expensive cancer treatments. Starting in 2014, there will be new caps on how much someone has to pay out-of-pocket for their care.

No more co-pays for recommended preventive cancer screening in new health plans and in Medicare.

Health plans can't deny access to approved clinical trials and must help cover costs for participating in a clinical trial.

Starting in 2014, US citizens and legal residents will be required to have health insurance or else pay a yearly tax penalty. [3] This is called the individual mandate. The penalty would start at $95 or up to 1% of income (whichever is greater) in 2014 and would go up to $695 or 2.5% of income by 2016. For families the limit would be $2,085 or 2.5% of household income.

[2] It is important to note that many key policy decisions have yet to be made by federal and state government agencies involved in implementing the law. Details of implementation can also be influenced by the changing economic and political climate. The projections in these case studies are made to the best of our ability based on current understanding of the ACA and how its implementation is likely to unfold in the coming years.

[3] Exemptions will be granted for financial hardship, religious objections, American Indians, those uninsured for less than 3 months, undocumented immigrants, incarcerated individuals, those with incomes below tax filing threshold, and those for whom lowest cost plan is greater than 8% of their income.